What are the initial management steps for common medical emergencies?

Initial Management Steps for Common Medical Emergencies

The most critical initial management steps for common medical emergencies include rapid assessment of consciousness, airway-breathing-circulation (ABC) evaluation, activation of emergency response systems, and implementation of immediate life-saving interventions specific to the emergency condition. 1

General Approach to Medical Emergencies

Initial Assessment

• Determine if the patient is conscious or unconscious
• If unresponsive, immediately activate the emergency response system
• Assess for normal breathing (noting that agonal gasping is not normal breathing)
• Ensure scene safety before approaching any patient
• Call for help immediately upon finding an unresponsive patient 1

Airway Management

• Open the airway using head tilt-chin lift maneuver
• Remove any visible obstructions from the mouth
• Place unconscious but breathing patients in the recovery position
• Consider advanced airway management if needed 1

Breathing and Circulation

• Check pulse at the carotid artery (no more than 10 seconds)
• Look for signs of circulation such as movement or swallowing
• Begin high-quality chest compressions immediately if no pulse (100-120 compressions/minute, 2-2.4 inches depth)
• Provide ventilation with compressions at a 30:2 ratio 1

Specific Medical Emergencies

Cardiac Arrest

1. Recognize cardiac arrest (unresponsive with no normal breathing)
2. Begin high-quality CPR immediately
3. Apply AED as soon as available and follow prompts
4. Administer medications per protocol:
   • Epinephrine 1 mg IV/IO every 3-5 minutes
   • Amiodarone or lidocaine for refractory VF/pVT 1

Massive Hemorrhage

1. Control obvious bleeding points (direct pressure, tourniquet, hemostatic dressings)
2. Secure large-bore IV access
3. Obtain baseline blood tests (FBC, PT, aPTT, fibrinogen)
4. Begin fluid resuscitation with warmed blood and blood components
5. Actively warm the patient and all transfused fluids
6. Target systolic blood pressure of 80-100 mmHg until bleeding is controlled 2

Intracerebral Hemorrhage

1. Recognize early signs of deterioration (decrease in GCS)
2. Secure airway and provide ventilatory support if needed
3. Obtain immediate neuroimaging (CT scan)
4. Contact neurosurgical services promptly
5. Manage blood pressure appropriately
6. Reverse coagulopathy if present 2

Septic Shock

1. Recognize signs of septic shock
2. Obtain IV access and collect blood cultures
3. Administer broad-spectrum antibiotics
4. Begin fluid resuscitation
5. Start vasopressors if hypotension persists despite fluid resuscitation:
   • Epinephrine: 0.05 mcg/kg/min to 2 mcg/kg/min IV infusion, titrated to achieve desired mean arterial pressure 3

Anaphylaxis

1. Remove trigger if possible
2. Administer epinephrine (adrenaline) promptly
3. Position patient appropriately (supine with legs elevated if hypotensive)
4. Provide supplemental oxygen
5. Establish IV access and administer fluids
6. Consider additional medications (antihistamines, corticosteroids) 1

Monitoring and Documentation

• Monitor vital signs continuously (heart rate, blood pressure, respiratory rate, oxygen saturation)
• Reassess frequently to detect changes in condition
• Document critical information:
  • Time of symptom onset or last known normal
  • Interventions performed and patient response
  • Contact information for family members 1

Common Pitfalls to Avoid

• Delaying transport for unnecessary prehospital interventions
• Delaying CPR to check for pulse in lay rescuers
• Delaying activation of the emergency response system
• Prioritizing medication administration over high-quality CPR
• Inadequate compression depth during CPR
• Allowing interruptions during CPR
• Failing to recognize respiratory arrest versus cardiac arrest 1

Special Considerations

• In trauma patients, control hemorrhage first while maintaining minimal acceptable blood pressure
• For patients with suspected stroke, minimize on-scene time and transport rapidly to appropriate facility
• For patients with chest pain, administer oxygen to maintain SpO2 >94% and consider early ECG 2
• In mass casualty situations, implement appropriate triage protocols to prioritize care 2

Remember that the initial management of medical emergencies requires quick decision-making, proper resource allocation, and adherence to established protocols. The goal is to stabilize the patient and transport to definitive care as quickly as possible while addressing immediate life threats.